Diabetic nephropathy in the elderly – clinical practice

Common health problems of the elderly in the near future will become even more common with aging of the population and longer average life expectancy. The elderly tend to have multiple disorders at one time, some of which may aggravate the course of others. One of the most common diseases, diabetes – “the epidemics of XXI century”, treatment of which costs approximately 11% of world health care budget – is the leading reason of chronic kidney disease and end-stage renal disease. Diabetic nephropathy can be a complication of both diabetes mellitus type 1 and 2. The most numerous group of patients with recently-made diagnosis are these above 60 years of age. Albuminuria, which, depending on its intensity, is one of the diagnostic criteria, can appear even in the process of aging itself. Overlapping of structural and functional changes that develop with age and those caused by diabetes is therefore a challenge, both diagnostic and clinical. There are certain methods of early diagnosis and prevention of progression of diabetic kidney disease. There is, however, no targeted treatment and existing therapies are generally based on glycemia and blood pressure control. Some patients in the advanced stage undergo dialyses just like in other kidney failure cases. The course of the disease is influenced by modifiable factors, such as protein and salt intake or cigarette smoking. In the light of the fact that this problem will concern an increasing number of patients, diagnostics and treatment can and should be introduced in the early stages of the disease. This all fits within the recently popular “healthy aging” ideology. Its popularization and implementation can bring measurable benefits of social and economic character.